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. ` � <br /> ` ,2�.r <br /> t <br /> � '� C��_ <br /> r�F_c'+�' ���� '��, , <br /> ��3 � ^ <br /> r r�t <br /> �'� . �A � <br /> �£�.�� �,'� 5 � �s,� �i� i � O� ��� � <br /> -� �-; - <br /> �_. �; ��,.: <br /> . ,�'���=:=�`�,��.�' <br /> �., <br /> """ �;. � Post Office Box 66•CrystaI Bay,Minnesota a�323•hiunicipal ' c� <br /> ����3' ' <br /> •�+'•,�;:.:�.;, f1 _. <br /> ' e.s,r�i=,, <br /> �� � On the North Shore of Lake itifinnetonka <br /> a � s+�� <br /> DATA PRNACY ADVISORY <br /> In accordance with M.S. 13.04, Subd. 2, "Rights of subjects of <br /> data" , we would Iike to inform you that your request for a yerm ire <br /> license from the City of Orono or any of its departments ma req <br /> you to furnish certain private or confidential information. <br /> You are notified that: <br /> 1. The informa�i�heY°ermit or li ensebreques ed, determine your <br /> qualification fo P <br /> 2, You may refuse to supply data, but refusal may require that <br /> the City deny the permit or Iicense. <br /> 3. The information may be shared with other loca'_, state or <br /> federa3. agencies to the extent necessary to process the permit or <br /> license. <br /> 4. If your requested permit or Iicense requires Councii action <br /> to approve, some information may become public. <br /> 5, You have certain rights under M.S. 13.04 to review pri�a�� <br /> data on yourself. <br /> 6, Yaur full name is required to process this applicatian oi <br /> permit. <br /> '� � � � � <br /> � � �� Las� <br /> First Middle <br /> �' �'' >�.�c�C'�- � � <br /> Addr,ess � -. � � <br /> � 1 !� � <br /> , � Z1D <br /> City " State <br /> � � �� ( . <br /> �=�i�-- ��/�� � �� S <br /> Phone . <br /> I understand y ._z:i�.�s���tated above. <br /> � , / <br /> �� <br /> � <br /> i at�` <br /> � <br /> �:"- , <br /> BUILDiNG&ZONING—473-7357 • ADMINISTRAT'IO`!&FIN�yCE—473-7358 <br /> • PUBLIC WORKS —473-7359 <br /> ASSESSING <br />